The efficacy and side effects of
lactitol in the treatment of chronic
hepatic encephalopathy was compared to that of other
disaccharides in a meta-analysis of published randomized clinical trials (RCTs). The outcomes assessed were: (1) the rate of patients free from episodes of clinically detectable
encephalopathy, and (2) the rate of patients free from one or more side effects in the different treatment groups. Four RCTs were eligible for analysis; in three
lactitol was compared to
lactulose, in one the alternative treatment was
lactose in
lactase-deficient patients. The methodological quality of these studies was high. Meta-analysis showed that
lactitol was as effective as other
disaccharides in the treatment of
encephalopathy: pooled odds ratio was 0.83, 95% confidence interval was 0.38-1.82. Results were not sensitive to the use of alternative methods of counting and attributing events in these trials. Patients experienced fewer side effects during treatment with
lactitol, but the pooled odds ratio was not statistically significant. In all studies
lactitol was considered more palatable. Clinical effectiveness of
lactitol, in long-term treatment of
chronic encephalopathy, is similar to those of
lactulose. It seems that
lactitol has lower side effects than
lactulose. Future RCTs with a double-blind design could be mainly aimed at evaluating the side-effect profile of the two
disaccharides.